T Nation

Started TRT, Help with Plan?

Hi everyone, I would really appreciate some feedback and help with my therapy I have started. Very informative and smart people on here, I value your guy’s opinions. Now to get started.
Weight: 250lbs (overweight, however weight distributes evenly on my body, chest, stomach, ass, legs) people think I look “big” as opposed to generalized fat.
Symptoms: General laziness, lack of motivation, tired, sexual desires half of what it used to be (always horny lol). Used to be 230-240lbs, now 250.
Vices: Used to smoke alot of weed, quit for couple years now. Drink hard alcohol on weekends, usually alot, cut that down to almost completely zero for the last 3 to 4 weeks. Smoked cigarettes only when drinking, do not otherwise.
Supplements: Multivitamin, Vitamin D, Vitamin B, Omega 3-6-9, Probiotic, Milk thistle (just started)
TRT: Delatestryl Test Enthanate @50mg shot twice a week.

Backstory: Due to just general lack of life enjoyment etc, and trying for a kid, my GP had my testosterone tested. It came back low, he referred me to a urologist. While waiting for my Urologist appoint, wife got pregnant. I still decided to see the urologist, after much research on this site and others, regarding the benefits of TRT. I have alot of “juicer” friends and see them in shape and living life like they are still 20, energy etc related. I dont want to abuse, I just want to feel like im supposed to and not like an old man.

Urologist had me retested (I will post results) and said I was considered “low normal” and that I would qualify for trt, atleast to see how I felt on it, the choice was mine. I was pumped, as I had always wanted to try test, and what better way than pharmaceutical grade, and under a doctors supervision. He prescribed me 200mg every 2 weeks, offered numerous applications, eg gel, nasal spray etc, from my knowledge I opted for the Injection. Loaded with this info I started heavily researching. Right off the bat I found the dosage should not be every 2 weeks, in order to avoid the peaks an valleys, which the Doc even mentioned. I decided against getting on it right away, due to the research I was doing along with wanting to change my diet and start working out prior to starting therapy. I want to maximize the benefits and do this properly.

I have started working out, plus cardio for the last 4 weeks. My diet is much better than it was, cut out processed foods, and heating much cleaner finally, still not 100% but way better than I was. During this time I was supposed to see my Doc for a follow up appoint as far as he was aware, I had started. I went to the appt and explained why I had not started, regarding, proper diet, exercise etc, he was all for it, I explained the peaks and valleys he mentioned could easily be avoided If I was taught to self administer twice a week at 50mg per shot. He was also supportive of this. He asked if I planned to have more kids, I said its a possibility, after some discussion regarding hcg, and stacking. He said he follows the American Urological Association guidelines for TRT. He suggested I try HCG first. I still wanted to do test, as I have seen alot of you guys mention doing the HCG with it if anything. So he gave me my first shot to start, May 24th @200mg, told me to get my next shot on May 30th @50mg, and basically start giving myself 50mg shots every Monday and Thursday.

Here are my concerns, im finding alot of extremely knowledgeable people on this forum are far more informed than my urologist. As soon as I found out the whole 2 week shot he suggested was a bad idea, I knew I had to monitor my therapy myself, with hopefully your guys guidance. So the doc has told me to start my therapy which I have, and now my follow up blood work is for first week of July. I asked him regarding Estrogen or E2 blood work as a baseline and he said not needed, I dont think he even checked my SHBG. These are now my concerns, and would very much appreciate the help please.

  1. Apart from the blood work the urologist has had me do already. What is missing or what I should get, now before July, and also what should I make sure is included for the July test. I spoke to my family Doctor and informed him I started my treatment and need some extra blood work done which the urologist was not concerned about. I am seeing him on Monday 3rd, he said to bring in which tests I would like for him to do, for example I know I need my SHBG, E2 estradiol, cholesterol levels checked. He was being supportive. I am 2 shots in. Monday will be my 3rd @50mg

  2. I have not done my thyroid temperature check as suggested by KSMAN, I always forget to do it first thing in the morning. Do I need to do it, according to my bloodwork?

3.I am concerned about hairloss, I understand its related to DHT, which I dont think has been tested yet. Should I take saw palmetto now as a preventative, or wait?

4.I somewhat have bitch titties as I carry weight around my chest also, I dont think its estrogen related but rather just fat, I really want to make sure I dont have any estrogen problems. I am eating lots of greens now, including kale shakes in morning and boiled broccoli, anything else I can do prior to having it checked through blood work.

  1. I do want to try for another kid maybe 8 months down the road. Should I look into HCG now or its ok to wait further down the road.

  2. Along with the supplements I mentioned in the start, what else should I be taking and at what dose.

  3. In your guys honest opinion as I value it alot, is it ok for me to continue with the treatment, or perhaps stop and address something you guys recommend before really being fully committed. Especially as I know I dont have a complete blood report as the urologist really should have done. I would rather stop now than be few weeks in and go through a “deep valley”

I apologize If I have rambled on too much. The above questions are the start of my concerns, I really hope you experts can guide me in the right direction. I would love if I can get a set of guidelines and a to do list I can easily follow and maintain. Thanks again for taking the time to read through this and sending knowledge, advice, suggestions, and opinions my way, Im relying pretty much on you guys and this forum to do this right, as my urologist from what I can tell is pretty limited in this field, and only beneficial for the prescription. My family Doc on the other hand is willing to support and listen to what I have to say regarding the proper way to undertake this treatment. Thanks again.

My doc emphasized before my first kid I had to inform him six to twelve months before I wanted a pregnancy to happen. I took no time off HCG in between my two kids, one who is due this August. I’m not stopping HCG until we have an intended third one.

Taking your body temp on waking on nonsense, it comes from a quack named Wilson and his “Wilson’s Syndrome”. Complete crap. You can be on TRT and conceive, most likely. Everyone is different, but it’s not an issue for most.

Start TRT with an iron deficiency and you are set to crash and burn. I started TRT with a severe iron deficiency and started experiencing severe life threatening symptoms that forced me off TRT. Your MCV and MCH are both abnormally low, meaning the mass and size on hemoglobin is very tiny and you can have normal hemoglobin with iron deficiency, "iron deficiency without anemia’ or “hypochromic anemia”.

An iron panel is recommended.

Thanks for the responses so far guys. Couple things. The having kids thing isnt bugging me as much now that I have those responses.

So forget the body temp tests? I wonder why its stickied as a must to do. Does this blood work show my thyroid as functioning anyway?

The MCV, MCH abnormality was bugging me also. Thank you so much for addressing it. I WILL add and request from the GP to get me a complete iron panel for Monday. Its funny you mentioned this. I havent gotten the kick I was expecting from starting TRT. I am feeling it, however Im finding im still tired, I have found I sleep well on it, however struggle to wake up in the morning without being groggy. Shall I start taking a iron supplement now? if so how much? or should I wait to get blood work done on Monday?

Thanks again guys, hoping some of the other concerns I have can be answered also please. This is why im here, the urologist didnt say shit to me about the abnormality.

I always had more fatigue pushing higher than 400 ng/dL, strange considering a had low energy in the 400’s and would expect more energy in the 500’s, not less. When scoring higher than 500 I wanted to sleep all day and had a very short burst of energy and became fatigued easily.

Then I did an iron panel while on TRT and after stopping TRT for a week, I watched my serum iron increase to barely within ranges which still showed iron deficiency on other testing. TRT can worse existing deficiencies and cause new ones including magnesium and pregnenolone.

I would run serum iron, total iron binding capacity and iron saturation.

Systemlord, shall I stop in order to get my iron in check or start taking supplement now? I just took 2 feramax pills today. Thinking to continue the trt and take feramax then perhaps check the blood panel test in a week or 2? What do you suggest? Thanks

We already know there’s a deficiency so no point in stopping TRT, unless the reason for low testosterone is do to an iron deficiency. Your iron labs are shockingly similar to my iron labs taken weeks ago.

It’s your call, but we know our testosterone isn’t optimal after 40 and you’re close to the age when men are forced to start optimizing testosterone.

Your doctor is operating outside his area of expertise and is screwing up badly by missing the iron deficiency, you have no thyroid testing. Urologist do not specialize in this area of medicine, their field of expertises is limited, truth is there is no doctor in sick care that specializes in hormones such as testosterone.

TRT has been ignored in western medicine for a long time. You’ll likely never find a good TRT doctor in sick care, they are all in private practice in anti-aging and sports medicine. The majority of endocrinologists, urologist and GP’s do not specialize in TRT and most will be clueless.

You cannot count of them, you have to educate yourself to vet your doctors. You spend a few hours educating online, now you know more than your doctors. No joke, this is how little they actually know, shockingly little.

Yes, and many others also wonder. You did not get any thyroid tests. You want TSH, free T4 and free T3 tested, at least. Possibly reverse T3 and antibodies as well.

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Ok cool thanks system. I took a couple feramax today, shall I continue with it for a week and then get the iron panel done a week later? Or just have it done on Monday?

Did you get your iron in check now, and how?

Thank you for your input also highpull. I have added the thyroid panel and iron panel added to my list to take to the doctor for Monday now.

Any other blood panels I should request for tomorrow? Thanks

Hey systemlord possible to email or msg u directly pls, especially considering we have the same iron issue. Got my family doc appt tomorrow, want to make the best of it, otherwise it takes weeks to get an appointment to see him. Thanks

You should definitely check you ferritin and TIBC, but I wouldn’t be too worried about it in your case. Your RBC is high, which is an indicator that you are not anemic. The MCH and MCV are barely below range, so unless you have other blood work that shows a pattern it is likely insignificant.

Thank you for your reply hardartery. I have added them to my list for tomorrow now also. I feel a bit better once you mentioned you dont think im anemic. I have double dosed feramax to hopefully bring my MCH and MCV up before my blood work. I would really somehow like to be balanced throughout my blood work before im 3 or 4 weeks into my therapy. I do feel my iron is low however as systemlord has suggest, as I am always tired and have few other symptoms I found associated with low Iron. Havent been getting the kick I was expecting from my shots thus far. Hope this fixes it lol.

I did recheck iron, iron binding capacity and iron saturation was 1% below a deficiency (19%) and needs to be >25% to be optimal, I had to increase daily iron intake from 325mg to a whopping 650mg.

Damn I was iron deficient!

Go to Excelmale, we can PM there.

You can have iron deficiency with normal hemoglobin, the mass and size shrink when iron is low.

Yes, but he is so barely low that it would seem unlikely in his case. Another blood test would be needed to see if it’s a fluke or a pattern

Ok cool I’ll jump on excelmale also.

Thanks again for replies. I do my next 50mg shot tomorrow. And also see the doc. Should I do the iron blood work tomorrow or before my next shot? What do u guys suggest.

It shouldn’t matter when you do labs for iron.

Get a new Doc . World link medical database google that. All the docs have gone to dr Rouzier (the wizards of HRT) classes and are certified by him to practice HRT.

You can’t go wrong seeing one of these
Docs. Jsut listen to Rouzier talk on YouTube and you’ll find quickly this is a great way to do trt.

You shouldn’t be the guy figuring out the basics in thyroid and other lab tests.

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